West Coast Spine Restoration Center

Initial Business Response / [redacted] (1000, 8, 2016/07/22) */ We will address the claims made against West Coast Spine Restoration Center (WCSRC) and the Consumer's Complaint of Fraudulent Billing Practices Ms [redacted] was attending physical therapy at our clinic at the end of (yr2014) and as a courtesy to our patients, we do not ask for cash upfront for services rendered, we bill the patient's insurance company and wait for reimbursementWe rely on the information the patient gives to us regarding their personal address and phone number information as well as what the patient gives us regarding their insurance address and billing information As we came to understand, Ms [redacted] provided us with incorrect personal address informationAs far as the insurance information, in 2014, all was correct, so we did not have to contact her personally because her insurance company was paying for services rendered in a timely fashion and they were also sending her copies of EOB's (Explanation of Benefits) for services rendered and payments made In January 2015, (new year) Ms [redacted] did not inform this clinic of a change in her insurance informationThis is the patient's responsibility to update medical facilities of any changes of their insurance so that these problems do not occurTherefore, since we were not informed, patient's old insurance continued to be billedHowever, payment was not received by us and after several months of not receiving payment for services rendered, our protocol is to send the patient a bill so that they will know of the communication errors and billing problems and will be able to assist us by providing us with updated information so that we can correct our files and resend the bills to the proper insurance companyWe heard nothing from the patient after several letters and bills went out to her PO BOX month after monthHer last treatment occurred in February Ms [redacted] was then referred on to our collection agency in December 2015, almost a year laterShe paid the collection bill in January Ms [redacted] then came into the clinic in early February (after paying the collection agency) and met with our billing representativeShe gave the representative the updated and correct insurance information that should have been given to us back in January and when asked to verify whether or not we had her correct mailing address, because of all the returned mail, she stated that she had made a mistake and provided the representative with the correct information at that time as wellMs [redacted] informed the billing representative that she had paid the collection agency and was upset and not happy about being sent to collectionsShe explained that she had this "new insurance" which was an HMO and she believed that she should not have received a bill from usShe also informed the Representative that she did not need any further assistance from our billing service to resolve the issueHer characterization and claim that we would intentionally and fraudulently bill is unfair and not truthfulWe as a healthcare provider can only rely on what the patient provides as information for billing purposes for benefit coverageIf this information is not provided in a timely fashion or if the information is not correct information (see attached Financial Responsibility Agreement- Responsibility for Payment) that we receive, these problems are more likely to occur In closing, we have been in business since and we pride ourselves in customer satisfaction and quality of care as being our highest priorities and we take this very seriouslyIn healthcare/billing reimbursement there is a timeframe called "timely filing" which there is no appeal process that we are subject to as health care providersTherefore, if the patient had provided the correct and updated information in this window of "timely filing" she would have avoided all these issues As a courtesy to this patient we will reimburse her payment that she made to the collection agency minus any PPO policy co-insurance responsibility she has Ms [redacted] should contact the E&A Group Collection Agency to receive payment Very truly yours, [redacted] Billing Representative [redacted] Director Initial Consumer Rebuttal / [redacted] (3000, 10, 2016/07/28) */ (The consumer indicated he/she DID NOT accept the response from the business.) My full, 4-page response with attached documentation has been sent to the Revdex.com [redacted] @Revdex.com-email.org

Initial Business Response /* (1000, 8, 2016/07/22) */
We will address the claims made against West Coast Spine Restoration Center (WCSRC) and the Consumer's Complaint of Fraudulent Billing Practices.
Ms. [redacted] was attending physical therapy at our clinic at the end of (yr. 2014) and as a...

courtesy to our patients, we do not ask for cash upfront for services rendered, we bill the patient's insurance company and wait for reimbursement. We rely on the information the patient gives to us regarding their personal address and phone number information as well as what the patient gives us regarding their insurance address and billing information.
As we came to understand, Ms. [redacted] provided us with incorrect personal address information. As far as the insurance information, in 2014, all was correct, so we did not have to contact her personally because her insurance company was paying for services rendered in a timely fashion and they were also sending her copies of EOB's (Explanation of Benefits) for services rendered and payments made.
In January 2015, (new year) Ms. [redacted] did not inform this clinic of a change in her insurance information. This is the patient's responsibility to update medical facilities of any changes of their insurance so that these problems do not occur. Therefore, since we were not informed, patient's old insurance continued to be billed. However, payment was not received by us and after several months of not receiving payment for services rendered, our protocol is to send the patient a bill so that they will know of the communication errors and billing problems and will be able to assist us by providing us with updated information so that we can correct our files and resend the bills to the proper insurance company. We heard nothing from the patient after several letters and bills went out to her PO BOX month after month. Her last treatment occurred in February 2015.
Ms. [redacted] was then referred on to our collection agency in December 2015, almost a year later. She paid the collection bill in January 2016.
Ms. [redacted] then came into the clinic in early February 2016 (after paying the collection agency) and met with our billing representative. She gave the representative the updated and correct insurance information that should have been given to us back in January 2015 and when asked to verify whether or not we had her correct mailing address, because of all the returned mail, she stated that she had made a mistake and provided the representative with the correct information at that time as well. Ms. [redacted] informed the billing representative that she had paid the collection agency and was upset and not happy about being sent to collections. She explained that she had this "new insurance" which was an HMO and she believed that she should not have received a bill from us. She also informed the
Representative that she did not need any further assistance from our billing service to resolve the issue. Her characterization and claim that we would intentionally and fraudulently bill is unfair and not truthful. We as a healthcare provider can only rely on what the patient provides as information for billing purposes for benefit coverage. If this information is not provided in a timely fashion or if the information is not correct information (see attached Financial Responsibility Agreement- Responsibility for Payment) that we receive, these problems are more likely to occur.
In closing, we have been in business since 1992 and we pride ourselves in customer satisfaction and quality of care as being our highest priorities and we take this very seriously. In healthcare/billing reimbursement there is a timeframe called "timely filing" which there is no appeal process that we are subject to as health care providers. Therefore, if the patient had provided the correct and updated information in this window of "timely filing" she would have avoided all these issues.
As a courtesy to this patient we will reimburse her payment that she made to the collection agency minus any PPO policy co-insurance responsibility she has.
Ms. [redacted] should contact the E&A Group Collection Agency to receive payment.
Very truly yours,
[redacted] Billing Representative
[redacted] Director
Initial Consumer Rebuttal /* (3000, 10, 2016/07/28) */
(The consumer indicated he/she DID NOT accept the response from the business.)
My full, 4-page response with attached documentation has been sent to the Revdex.com [redacted]@Revdex.com-email.org.